Acute obstructive pancreatitis secondary to migration of a gastrostomy tube into duodenum

Percutaneous endoscopic gastrostomy (PEG) tube is a common procedure. This discusses the rare complication of acute pancreatitis, due to tube migration, causing obstruction of the ampulla of Vater. Radiological confirmation of tubes prior to usage may aid in preventing this reversible complication.

Delayed gastric perforation following nasogastric tube insertion: the pitfalls of radiographic confirmation

A man in his 70s, admitted to intensive care unit following an out of hospital cardiac arrest, had a nasogastric (NG) tube inserted on admission. Correct placement of the NG tube had been confirmed using National Patient Safety Agency (NPSA) criteria and was used for feeding without incident. He remained intubated and ventilated throughout his stay. On day 9 his oxygen requirements increased with subsequent chest imaging revealing an incidental gastric perforation secondary to NG tube migration. The NG tube was removed intact and undamaged. The patient appeared to improve without sequelae from the perforation or signs of abdominal sepsis. Unfortunately his condition deteriorated due to a large right atrial thrombus and life sustaining treatments were withdrawn.

Silicone Y-stent insertion under extracorporeal membrane oxygenation (ECMO) in a patient with tracheal tear

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.

Migration of Feeding Tubes Assessed by Using an Electromagnetic Device: A Cohort Study

Background Bedside methods to verify placement of a feeding tube are not accurate for detecting placement within the gastrointestinal tract, increasing risk of pulmonary aspiration. Current guidelines recommend verifying placement every 4 hours, yet the rationale for this recommendation is unknown. Objective To assess spontaneous migration of small-bore feeding tubes in critically ill adults. Methods A prospective, repeated-measures cohort study was performed in 2 intensive care units. An electromagnetic placement device was used to assess distal feeding tube location every 24 hours for 7 days. Tube migration between zones—esophageal, gastric, and postpyloric— was considered clinically significant. Results Feeding tubes were analyzed in 20 patients. Interrater agreement was substantial for round 2 of a blinded analysis of insertion tracings (g = 0.78); 100% agreement was achieved after unblinding. Among 62 outcomes (migration assessments), 4 feeding tubes migrated 8 times (3 forward and 5 retrograde). All migrations occurred in the postpyloric zone and none were clinically significant. Within 24 hours of insertion, 50% of feeding tubes had migrated forward. Repeated-measures analysis showed a greater likelihood of migration in patients with an endotracheal tube (relative risk, 3.46 [95% CI, 1.14-10.53]; P = .03). Conclusions No tubes migrated retrograde into the stomach or esophagus, challenging the practice of verifying placement every 4 hours. Verification every 24 hours may be adequate if migration is not suspected. Also, lack of visible anatomical structures on insertion tracings from an electromagnetic placement device make subtle changes in postpyloric placement difficult to identify accurately.

Duodenal obstruction secondary to percutaneous endoscopic gastrostomy tube migration

Resumen La inserción de la sonda de gastrostomía percutánea es un procedimiento seguro con bajo índice de complicaciones. Presentamos el caso de un paciente portador de gastrostomía, en el que se colocó una sonda de tipo Foley que migró a intestino delgado a través del píloro, produciendo un cuadro de obstrucción duodenal. Esta complicación es más frecuente con sondas tipo Foley, por lo que se recomienda el recambio precoz en las primeras 24 horas a una sonda de gastrostomía con adecuado sistema de sujeción a la pared abdominal.